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ARTICLE |

Spinal Anesthesia FREE

Fred J. Spielman, MD; Charles B. Watson, MD
[+] Author Affiliations

Reprint requests to Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, NC 27514 (Dr Spielman).


JAMA. 1983;249(6):734-736. doi:10.1001/jama.1983.03330300026027
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SINCE its introduction by August Bier in 1898, subarachnoid spinal anesthesia has provoked more continuous controversy than any other anesthetic technique. The very mention of the procedure elicits a stress response from our patients and colleagues as they recall reports of complications ranging in severity from unremitting headache to irreversible paralysis after subarachnoid block. However, this relatively simple procedure is widely employed because of the excellent analgesia and muscle relaxation it provides and the absence of respiratory tract irritation and cardiac depression associated with its use in controlled situations.

Spinal anesthesia results from the temporary interruption of nerve transmission after injection of a local anesthetic solution into the subarachnoid space. The local anesthetic agents act on the spinal nerve roots and, possibly, the posterior and lateral areas of the spinal cord.1 The rapidity of the onset of anesthesia is related to the diameter of nerve fibers. The smallest fibers

REFERENCES

Bromage PR, Joyal AD, Binney JC:  Local anesthetic drugs: Penetration from the spinal extradural space into the neuroaxis . Science 1963;;140:392-393.
Bridenbaugh PO, Kennedy WF Jr: Spinal, Subarachnoid Neural Blockage, Neural Blockage , Cousins MJ, Bridenbaugh PO (eds). Philadelphia, JB Lippincott Co, 1980;, p 168.
Freund FG, Bonica JJ, Ward RJ, et al:  Ventilatory reserve and level of motor block during high spinal and epidural anesthesia . Anesthesiology 1967;;28:834-837.
Jones RJ:  The role of recumbency in the prevention and treatment of postspinal headache . Anesth Analg 1974;;53:788-796.
Lund PC: Principles and Practice of Spinal Anesthesia . Springfield, Ill, Charles C Thomas Publisher, 1975;, p 631.
Moore DC, Bridenbaugh LD, Bagdi PA, et al:  The present status of spinal (subarachnoid) and epidural (peridural) block . Anesth Analg 1968;;47:40-49.
Lund PC: Principles and Practice of Spinal Anesthesia . Springfield, Ill, Charles C Thomas Publisher, 1975;, p 173.
Goldman WW, Sandford JD:  An 'epidemic' of chemical meningitis . Am J Med 1960;;29:94-101.
Ferguson-FR, Watkins KH:  Paralysis of the bladder and associated neurological sequelae of spinal anesthesia (cauda equina syndrome) . Br J Surg 1937;;25:735-752.
Winkleman NW:  Neurologic symptoms following accidental intraspinal detergent injection . Neurology 1952;;2:284-291.
Gordh T:  On spinal anesthesia—experiences over 40 years . Region Anesth 1979;;4:3-8.

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Bromage PR, Joyal AD, Binney JC:  Local anesthetic drugs: Penetration from the spinal extradural space into the neuroaxis . Science 1963;;140:392-393.
Bridenbaugh PO, Kennedy WF Jr: Spinal, Subarachnoid Neural Blockage, Neural Blockage , Cousins MJ, Bridenbaugh PO (eds). Philadelphia, JB Lippincott Co, 1980;, p 168.
Freund FG, Bonica JJ, Ward RJ, et al:  Ventilatory reserve and level of motor block during high spinal and epidural anesthesia . Anesthesiology 1967;;28:834-837.
Jones RJ:  The role of recumbency in the prevention and treatment of postspinal headache . Anesth Analg 1974;;53:788-796.
Lund PC: Principles and Practice of Spinal Anesthesia . Springfield, Ill, Charles C Thomas Publisher, 1975;, p 631.
Moore DC, Bridenbaugh LD, Bagdi PA, et al:  The present status of spinal (subarachnoid) and epidural (peridural) block . Anesth Analg 1968;;47:40-49.
Lund PC: Principles and Practice of Spinal Anesthesia . Springfield, Ill, Charles C Thomas Publisher, 1975;, p 173.
Goldman WW, Sandford JD:  An 'epidemic' of chemical meningitis . Am J Med 1960;;29:94-101.
Ferguson-FR, Watkins KH:  Paralysis of the bladder and associated neurological sequelae of spinal anesthesia (cauda equina syndrome) . Br J Surg 1937;;25:735-752.
Winkleman NW:  Neurologic symptoms following accidental intraspinal detergent injection . Neurology 1952;;2:284-291.
Gordh T:  On spinal anesthesia—experiences over 40 years . Region Anesth 1979;;4:3-8.
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